Adam Blatner, M.D..

(Posted February 12, 2010)

As mentioned in the paper (also posted on this website) titled ‘Shrink’ or ‘Expander,' the field of psychotherapy has emerged and gone through at least two phases: In the first phase, the model of dis-ease and healing involved opening to the powers of the unconscious mind. Such practitioners imagined themselves as expanding the options available to people through the power of truth, of knowing the issues involved in the pitfalls and temptations of self-deception.

However, as fields develop, it is common that earlier theories and sets of assumptions come to be thought of as being too limited. To the extent that some professionals sought to explain their patients’ problems according to these early theories, the slang term “shrink” functioned not only to reduce the status gradient and degree of vulnerability of patients in the mid-late 20th century, but also to express how the “old-fashioned” therapists’ work appeared in the eyes of the next generation, which was more integrative, eclectic, and open to the human potential.

Yet, ironically, even this generation of psychotherapists with their wider range of ideas about what made people “sick” and what could be done to help them might be viewed as still restricted by their role and world-view, might still be thought of as slightly shrink-like, because many of the actual factors in psycho-social dis-ease require diagnosis and remediation at the level of the culture, the body politic, the overall social system of norms and expectations. Such a challenge is vastly more difficult, and no single person can do all that much. (The line, “It takes a village to raise a child” may illustrate this problem.)

The key is the word “hygiene,” which means preventive medicine, activities the individual, family, or the whole society can do to prevent disease before it even happens. (There are other gradients of prevention, too: Early and prompt treatment can prevent complications; and adequate treatment of complications can prevent even more problematic secondary and tertiary complications. So, for example, early stroke treatment with physical therapy can often reduce long-term disability.)

Still, it seems valid for me to at least begin the process by attempting to name the issues, to identify and clarify the nature of the problems involved. The key is to recognize that cultural factors can affect mental hygiene as much as public health measures (which often involve fundamental political activities) may be necessary to affect physical hygiene. The following themes are among those that I imagine will become recognized as being factors in psycho-social distress and dysfunction:

Ignorance and Education

I’ve been impressed in my over forty years in clinical practice and teaching that most people lack what I consider to be fairly basic information about the nature of the mind and relationships. I think these ideas should be taught in the mainstream curriculum, especially in the middle and later years—from middle school through college. I think that many problems arise because folks have just never heard certain themes being talked about, discussed, clarified, informed. I consider this a kind of “psychological illiteracy.”

About a century ago, in the shift from a more rural and agrarian culture to a more urban and industrial society, learning how to read and write—acquiring literacy—became increasingly necessary for economic success. I think that today knowing how to develop the skills of self-awareness, communications, and interpersonal problem-solving are becoming as necessary for adaptation in a postmodern world as learning to read, write, and do arithmetic was a century past. I call these types of skills “psychological literacy.”

While some of this may be learned in therapy, I believe most should have been learned in school as a matter of public policy. It involves the way we (collectively) run public and private schools, and progress in this direction needs to recognize the prevalence of barriers of prejudice towards psychology!
It’s not just a matter of learning information. Skills need to be developed, practiced, and this also entails a shift from mere instruction to experiential practice. For example, I envision young people role playing situations that involve the exercise of tact, diplomacy, good manners, and more subtle communications skills.

It still is widely assumed that ordinary adults were adequately self-aware, but this is not so. Psychological literacy doesn’t come naturally with age, but needs to be learned specifically—again like reading and writing. As another analogy, for much of history it used to be thought that the average diet that didn’t starve one was therefore adequate—but that was before research had been done on vitamins, essential minerals, and other subtle nutrients.  Again, these are matters that involve not only education, but the general public that would support such policies, as expressed in the political and economic arenas.

Economic Injustice

Dare we propose that there could be a middle ground between the folly of state communism and exploitative capitalism? I think we need to recognize that political and economic systems that leave large numbers of people unnecessarily disadvantaged and poor tend to create a variety of consequences in terms of morale, the strength of the family or parental responsibility, peer group values, and so forth. It’s clear these contribute to higher degrees of social pathology, crime, cheating, addiction, and so forth, which in turn generate occasions of trauma and a far more pervasive incidence of post-traumatic reactions among victims and their families than might otherwise occur.

Not All Problems Can Be Solved Through Social Action

At this point, I think it’s necessary to note that of course there are many psychosocial  problems that will inevitably arise as part of the human condition. I think that people tend to retain childish attitudes and personal maneuvers, and these will need to be worked out as part of maturation. (See paper on the primal illusions.) Some anxiety, depression, and other symptoms accompany the mere process of adjusting to the realities of life. This happens even if parents are perfect in their role performance in every way. Given that, the goal of mental hygiene is not perfection, any more than the goal of physical hygiene would prevent every possible infection. (Indeed, a certain amount of infections of different kinds may actually strengthen the immune system and be necessary for optimal health, and, similarly, a certain amount of stress and distress may be optimal for helping people to learn to be optimally resilient.) Nevertheless, I am sure that there are also a great many sources of unnecessary stress, trauma, and folly, and I think that addressing these challenges to mental health also belongs in a realistic review of what might be the actual causes of psychiatric symptoms and socially destructive patterns.

Identifying Forms of Oppression

I define oppression as a situation in which the negative impacts are denied by certain key people, or the whole problem is ignored. The key is the mixture of denial and mere unconsciousness: Many people grew up in that value system and it has never occurred to them that it should or even could be different.

An oppressive system evolves into a controversy when a certain critical mass of critical people have been able to voice their criticism so that many if not most others at least have heard of their objections. Then there may be a period of years or decades (or centuries) where that new or alternative idea gradually gains enough reputability so that new norms become established.

Someone once said that a new idea is at first received with incredulity—those questioning the system must be mad or very wicked—; then contempt—those questioning the system are wrong-headed, merely childishly rebellious, or in other ways demonized. Finally, the idea that, say, women should vote or slavery is a bad thing becomes a norm.

What happens with each breakthrough, though, is that most people revert to feeling that now that this wrong has been righted, everything else is okay. The scarey truth is that there are many other oppressions that remain taboo and unconscious.

So, beyond psychotherapy, a higher consciousness approach includes addressing number 5, extending the list started in the previous section, working to clarify and justly ameliorate all potentially oppressive situations!

Subtle Oppressions

Once the idea of oppression is absorbed, along with the idea that there may be widespread social practices and attitudes that only benefit the more privileged—and sometimes even then not that much—, then one begins to wonder about our society:
    A. Appearance, the need to fit a rather narrow range of the sense of being attractive, involving hair, cosmetics, body build, clothes, fashionable accessories, tatoos, etc., leads to all sorts of syndromes that are not infrequently carried to excess—sometimes by the most high-striving of society (e.g., anorexia in dancers and models; plastic surgery in aspiring actors or media celebrities). Books are being written about this, but incredible amounts of money are being spent, and energies expended, and psychological distress experienced, for those for whom the ideal doesn’t come easy.
    B. The theme of uncomfortable clothing is worth mentioning, for men as well as women—clothes that are insufficient for when it’s cold, or too stuffy when it’s hot, too tight or bulky, that interfere with using the toilet, too sexy when one might not want to be seen in that role, and so forth.
    C. I think the dominance of the realm of imagination by the media and toy manufacturers, like competition, goes too far. There needs to be more time and activities that allow kids and adults to cultivate their own inner potential for imagining, rather than having the images packaged and delivered to them. I call this “imaginative oppression.”
     D. In the same sense, the commercial availability of games, social media, and distractions has made it difficult to discover the rewards of some degrees of solitude, which then confer some degrees of a sense of self-sufficiency. (I’m really talking about letting there be some balance in systems that may have become unbalanced.)

Need for a Realistic Philosophy of Life

Philosophy for a few centuries became the domains of religion, where it operated within a context of certain given assumptions; or the domain of academic philosophy, where professors and graduate students attempted to address the broadest problems in the most thorough fashions, which made the subject too dry, way too thick, and irrelevant to the general population. Of course there were implicit philosophies of life as played out in the major institutions and general culture, but few people were aware that they were using, struggling with, or disagreeing with the core issues involved.

I think that many people today who suffer even a little from the more common psychological symptoms are often stressed also by a confusing, misleading, excessively and un-necessarily guilt- or shame-producing, or inadequate philosophy or set of beliefs about what life is about. Their sense of meaning and what their purpose should be is correspondingly confused, watered-down, or even lacking. My impression is that this is pervasive, but if life is not particularly stressful, for many they go on, not for the moment needing the consolations of a more resilient philosophy.

For those under stress, though, the lack of such a philosophy can make a big difference in how well and with what effectiveness they can marshal their other psycho-social resources. (In medicine, to show an analogy, there is evidence that certain kinds of nutritional deficiencies can weaken the immune system’s effectiveness. So although it is the immune system that is the first level of defense, the overall nutritional status in turn affects the immune system. Similarly, the effectiveness of the cultural morale may affect personal psychosocial resilience.)

Work on generating a more effective popular philosophy may be a realistic goal for those thinking about mental hygiene in the broadest terms. (Again, from that standpoint, even the most broad-minded, most modern and eclectic psychotherapists are, relativistically speaking, “shrinks.”


For many people, a philosophy of life, their spirituality, and their religion are not significantly different, so the point to be made here is a further extension of the idea of addressing the transpersonal or spiritual dimensions in psychotherapy—but applying this beyond the therapeutic context.

I define spirituality as the activity—not a state of being, but an activity, a doing—the activity of developing a relationship with and/or deepening one’s sense of connectedness to the Greater Wholeness of Being. This Greater Wholeness may be symbolically personified as God or one of the other names for Divinity, or it may be non-personal, a set of cosmic and moral ideals or principles. The associated belief is secondary. People can be spiritual without adhering to this or that belief system.

The key, though, is that this greater relationship works to offer some sense of significance withing a grander system. Human life is not just getting by and getting what you can in the process. Nor is it just about the individual. A psychotherapist who represents a psychology that over-emphasizes individuality is almost by definition a shrink. Certainly I am, and promoting some degree of individuality is useful; but also we are, and a psychology and philosophy that doesn’t take that wider dimension into account is inadequate.

It used to be that this job was delegated to the minister. People were assumed to be affiliated with a religion that satisfied their existential questions. This turns out to be so wrong. Some people (perhaps most?) who are religious—in that they feel affiliated with an institution that tries to organize the spiritual impulse—have no idea how to go about becoming more spiritual, how to deepen or develop their connectedness. For them, mere membership suffices. And for some, certain religions don’t work insofar as truly helping them to find the solace and meaning that they hope to achieve.

The idea that religion and a full psychology can be separated is quickly becoming as untenable as the idea that body and mind, or mind and society can continue to be adequately thought about in separate compartments. Our present era is deeply inter-disciplinary, even if many of the practitioners of different disciplines, specialities, departments, and so on haven’t caught on yet.

Reducing Fear-Based Motivations

One of the more pervasive patterns in our culture has been its reliance on fear-based motivation. This takes a variety of forms, and the point here is that unless the culture as a whole rises up to challenge these types of oppression, they will continue to generate psychological distress.
     A. Competition. A certain amount of this is inevitable. Like intoxication or the seeking of distraction, this is part of the human condition, and we won’t be able to get “rid” of these components—nor, like all infections—should we. Some of these things might be good. The problem involves how much and too much. I think at present our culture doesn’t offer enough balancing respect to a host of non-competitive activities, games, art forms, modes of expression, and the like. We need both elements, with, I think, a slight weighting towards the non-competitive.
    B. A corollary of the above involves the generation of more participatory activities that allow for mediocre talent, more types of dancing, singing, drama, and other activities that don’t require one to be “the best.” There is a place for those who are so excellent they can charge for people to watch or hear their performance, but these cultural forms need not dominate our culture as much as they do.
    C. The point is that in a culture overly weighted to competitiveness, being less than the “best” becomes a source of humiliation and defeat, and this, I think, is a subtle form of oppression.
    D. I think the concept of hell is another widely held and surprisingly toxic belief. Many people can grow up and brush these stories aside, but many others who are a little more credulous or sensitive are deeply affected and bothered by such myths and it really poisons their psyches, sets up a kind of chronic, low-grade post-traumatic-stress-disorder-like syndrome. I think it’s time that physicians dared comment on this widespread practice. It’s as bad in my mind as female genital mutilation with germ-contaminated knives. That religious belief should be held to a standard beyond the concerns of health and hygiene is a common and too-often unquestioned assumption.
    E. Test-oriented education can also generate significant levels of stress in many kids. Some just drop out, while others suffer: The emphasis on the need to memorize dry facts with little time to warm up to their relevance is, I think, at present a predominant norm. It feeds the needs of education administrators to demonstrate the effectiveness of their role; one can easily test for the acquisition of information. But it messes people up during childhood and later, offers the misleading illusion that knowing facts is really a proof of intelligence, and that it offers protection from the actual challenges of life—92% of which do not involve the remembering of facts!

That major life challenges in work and learning can be met through luring people, encouraging them, and eliminating the fear factor—this new paradigm idea doesn’t seem to have entered the cultural mainstream, even though it is a common element in advanced management skills seminars.

Daring to Think Creatively

This is another extension of the aforementioned theme of promoting creativity as a core dynamic of psychotherapy. We must remember that not long ago for most people creative thinking itself was discouraged. Questioning was seen as impudence, and authority felt entitled to not having to justify its power. Schooling was an exercise in mindless obedience and the act of creativity was often confused with rebellion for the sake of wickedness itself. This was certainly in keeping with the dominant forces of religion, politics, and economics in the culture.

People who had developed a slave mentality, becoming accustomed to the constraints of the oppressive culture, joined with the authorities in hating the free-thinker, the heretic, the rebel. He was a threat to law and order, to the social fabric. He deserved to die by torture—and this punishment was enforced with relish. There was of course an element of jealousy: How come he gets to dare to be free when I have to participate in the enslavement of myself, mentally? If I have to become mindlessly obedient and feel virtuous in doing so, I’ll be damned (almost literally) if I am going to tolerate that person’s exercise of freedom. Of course I rationalize this by thinking of all the ways that creative person isn’t just creative, but wicked and dangerous.

Now, alas, we live in an era in which culture change has speeded up, and a capacity for flexibility and innovation makes one more adaptive, more valuable to employers. Our schools claim they support creativity, but in fact they do the opposite—only perhaps a little less repressively than in some other countries. Psychotherapy and other cultural activities need to participate in the cultivation and liberation of imagination, spontaneity, and creativity, and an adequate psychology needs to recognize the need for this—to be an expander, then, rather than a shrink.

Supporting Improvisation

This is an extension of the above idea. Moreno realized that most creative breakthroughs come from experimenting. Occasionally some come through flashes of inspiration, but even these were preceded by exploratory work, getting down and messing with the question. It requires a freedom to explore.

Encouraging the Spirit of Play

I think the essence of play involves a mixture of the spirit of exploration and the spirit of feeling relatively safe—especially in the social matrix. (Kids and grown-ups can tolerate more danger in some of their sports and still experience the activity as play.)

Play is a related concept. How can our culture offer more safe contexts so that people can be free to improvise, try things out, make mistakes with no significant consequences. The “play” of many organized sports at all age levels has become serious enough that a mistake is likely to engender significant feelings of humiliation in the eyes of others, shame, guilt, and other negative feelings, such as anger at others’ mistakes or disagreeing with a referee’s call.

And freedom for imaginative and expressive play is another realm—there are pervasive residual social norms that cannot differentiate spontaneity and imaginativeness with silliness or craziness—something to be avoided. I have been trying to advocate for a challenging of that blind and shallow prejudice.

Indeed, a subtle form of age-ism involves the attribution to childhood of many qualities we actually might benefit from in middle and later adulthood—imagination, playfulness, spontaneity, enthusiasm, expressiveness, and so forth. I call these not “young-at-heart,” but vitality. There’s nothing essentially “young” about them except for the fact that their precursors begin in childhood. The oppression involves the discomfort of teens in trying to act “grown up” and suppressing these qualities as too “baby-ish”—it’s an immature kind of over-shooting the mark.

Having Fun

Fun, like creativity, has been traditionally suppressed, because it seemed to interfere with work and submissive worship. Playfulness, though, is as much a part of human nature as sex. It represents the capacity to mix varying amounts of exploratory and experimental behavior with varying amounts of setting up contexts wherein those experiments are relatively fail-safe. Exploratory behavior almost by definition will grope, under-shoot and over-shoot the mark, and thereby make mistakes. Those mistakes symbolize a bit of breakthrough insight that for all our cleverness, we are vulnerable and foolish. In small doses, this tension between us-as-smart and us-as-fool is funny. The tension is relieved by the setting being safe, the mistakes being of little or no consequence, and this leads to laughter and a sense of thrill and fun.

This goes on at all ages with all tasks, and being able to set up tasks with this spirit, makes it a game, makes it playful. As the character of Mary Poppins sings is the prelude to the song, “A Spoonful of Sugar (Makes the Medicine Go Down)” in the classic 1950s Disney movie:
    In every job that must be done there is an element of fun.
    You find the fun and snap!, the job’s a game!

Most psychologies of the mid-20th century ignored the place of play in life, which was sort of the way that medicine, lacking the tools to appreciate it, hardly knew how to appreciate the prevalent influence of immunology in physiology until again the mid-late 20th century!  An expander as a therapist recognizes that to learn something that requires a degree of confrontation with the recognition that one may have been thinking in a mistaken fashion—a somewhat shame-producing operation—it is necessary to frame the larger therapy as a more pleasant and supportive experience, at a ratio of perhaps 70% fun to 30% work.

One way to make therapy more fun is to help the patient feel that s/he is learning a skill, or a group of skills, much like one learns to swim and shoot a bow and arrow and other things at camp. And learning at camp, if its done right, can be made to be more like play.

Expressiveness in Life

I mentioned in the other paper that another way to move from shrink to expander is to recognize that life involves far more than talk, insight, catharsis or tears. There is also the triumph of symbolically weaving sorrow or grief into a song or dance, representing one’s present re-birth as a sculpture, reflecting on foolishness and nascent wisdom in poetry, or participating in improvisational or even scripted drama. Ritual can partake of all of these elements and more, and further intensify and deepen consciously chosen activities of meaning-making. But this applies also to the challenge of realizing that the arts are being presently squeezed out of the curriculum, with perhaps some exception for programs that rest on competition. While developing excellence in artistic pursuit has merit, we need to recognize also that helping ordinary people exercise their ordinary levels of talent---sometimes mediocre or less impressive levels of skill---still does much to enlarge the personality. The point is to help people expand into their potential. I think we need to re-value and expand activities that have to do with not only vocational guidance, but also avocational guidance!

Beyond the creative arts, there is also self-discovery as well as self-expression in finding one’s talents in sports, physical activities, games, various types of recreation, occupation, home life, and every other human activity. This is an activity that celebrates the diversity of forms of growth and development. Mere insight and verbal formulations at best only ready someone to re-create their own lives in these various channels with more consciousness, but traditional therapy is itself only a foundation: A broader vision of therapy includes the wider patterns of growth, a fuller perspective on what education, celebration, expression, contemplation, loving and bringing others forth, too, belonging, and other activities are about.

Recognizing Addictions

Over the last century we have come to be more alert to an increasing variety of not only obvious addictions (e.g., alcohol or drug abuse) but also addiction-like patterns in which people come to overly rely on some illusory source of relief for their life challenges. This idea has only begun to penetrate the mainstream consciousness: Television and other media can become sort-of addictive, as can shopping, gambling, seeking sexual affairs, pornography, spending too much, maintaining one’s ideal appearance, following the news, or becoming otherwise overly obsessed with any source of distraction.

The trouble is that many of these quasi-addictions are all right and perhaps even beneficial when enjoyed in moderation—but there is too little general awareness and discussion of the pitfalls of overuse. Consciousness-raising is also needed for this problem.In the mid-20th century few psychologies had much of a handle (theoretically) on addictions, or if they did, they were something like this: If you had good insight, had worked through your complexes, then addictive substances or activities would have no hold on you. It was not so.

One of the more important developments in the later 20th century was the heightened recognition of the seductive power of certain addictive substances—no matter how seemingly healthy the person had been before their seduction. Several corresponding developments also happened: Family members were seduced into collaborating, colluding, “enabling,” because “If you loved me you’d love what I love.” Another development was the recognition that there could be many types of addiction just as destructive though not related to actual physiology—i.e, if not the somatic dynamics, then the psychosocial dynamics were almost the same: One could be virtually addicted to the pursuit of sex, gambling, shopping, food, gambling, over-spending, video games, television, and many other things. There are now self-help take-offs of A.A. for a surprising variety of activities. Part of being an expander includes noting the need to build awareness of and a socio-individual psychology that recognizes the social and culture pervasiveness of seductions into addictive-like behavior.

But how then to get “high” or have fun without getting drunk or satisfying the self symbolically through the addiction? An expander-therapy would also address the need to develop a repertoire of wholesome non-addicting forms of recreation, stuff that’s fun but also healthy. There are increasing opportunities for this, but in general, it’s not easy to find them in a culture that over-emphasizes competition and the use of the arts for performance for passive audiences rather than participation.

Another thing to avoid is too much vicarious experience, pseudo-experience that can give the illusion of “being alive” without any substantial involvement of self. There is such a thing as an excess of television, spectator sports and programs, and the like, and a relative lack of actual involvement in doing, experiencing, and developing.


Therapy in general helps build the implicit skilfulness of the patient in self-management. I think it would be a more expanding process by far if this could be made explicit: Patients should re-frame their role from slightly passive, the recipient of the ministrations of the mysterious doctor-doing-stuff, to a different role: The therapist becomes an educator-coach who will at times demonstrate and at times explicitly teach how to manage the many components of therapy—and most of those in turn can be re-framed as adjustments to the skill-set.

Part of this also entails the shift of identity of the client from one who slips from bare management into identification with this or that role, to an identity with the self as the inner manager, one who takes stock of the various roles to be played, notes how they are being played, considers what changes are needed, analyzes the points of problem, encourages the rest, addresses the problem as mediator, negotiator, considers all the inner voices, makes decisions, finds healthier outlets for less worthy motivations, and so forth. The self then becomes an artist, redefining, recreating his or her own life. The therapist’s maneuvers, as an expander, supports this shift in primary identity.

Another part of this involves the overall development of skills of critical thinking, more rationality, more sensitivity to the seductions of irrational thinking—this is part of what is known as cognitive therapy—and it adds to the overall enterprise of moving from barely adequate self-manager to excellent self-manager—worthy, indeed of promotion to chief executive ego.

Healthy Living

The needs of the body cannot be ignored. As public discourse is moving towards considering a national health care insurance program, issues related to a more conscious level of self-care are heightened. Diet, smoking, drinking, carelessness in driving, certain risky behaviors sexually and in sports, and so forth all are being noted with more focus, because folly in these areas may end up costing everyone far more money. Consciousness-raising in therapy is but a tiny part of this challenge---it needs to come into the public sector. Hippocrates, the legendary Father of Medicine, back in Ancient Greece, noted that a healthy mind resides in a healthy body. Thus, attention to exercise, avoidance of unhealthy habits, good diet, adequate sleep, stress-reduction and relaxation, and even such activities as regular flossing of the teeth all result in feeling better, having less pain, and having more energy available to really live.


In the past, therapists and the society as a whole tended to relegate questions about religion to the province of ministers. This includes struggles with identity, meaning, belongingness, purpose, and the like. The trouble is that while a small number have experience as chaplains who can work with people beyond their own faith tradition, most don't have such skills. Also, there are increasing numbers of people who (1) don't have any affiliation with a particular religion or denomination; and (2) really want to deal with their issues either in therapy or in non-therapy settings where there is no pressure for them to end up in any particular camp.

The key here is to disconnect the idea that teachers have to get students to believe the way they do, or even that there is a single objective truth that is right and all others are wrong. The paradigm shift needs to be towards a recognition that people construct their own meaning systems out of scores of sources, many of them involving the indvidual's personal network of people, book, and experiences. The point is to get more clear on finding some at least provisional ideas that one can then say, "this works for me." This philosophy of life can then be developed in time.

A related idea has to do with the emergence of a trend in psychology called “positive psychology.” This approach redeems the ethos of positive thinking that preceded Freudianism (and also enjoyed a resurgence in the work of Norman Vincent Peale and others in mid-century); yet does not depend on mere repression for its effectiveness. Another way to say this is that it isn’t enough to just correct weaknesses; it’s important to build up compensatory strengths. The habits of optimism and cheerfulness are not just results of feeling good—doing these even if you don’t feel good help you to feel good! This was viewed by mid-20th century psychology (incorrectly) as superficial. In truth, if there is no work on clearing up the knots in the psyche, then mere positivity won’t suffice; however, if there is only clearing up the knots and no positivity, there isn’t an adequate pay-off to reinforce whatever gains are made. Both approaches are needed—and the others also mentioned above. Practicing optimism is by no means an avoidance of the dark side of human nature, but dwelling only on the dark side is a limited perspective.

Other forms of “expansion” include imagination development, which complements all of the other themes. Together, they lead to another category that shrinks don’t have, as far as I can tell—a vision of what more-than-mere-normalcy entails: I’m speaking of flourishing, a kind of psychological vitality; and “deep maturity,” a more expanded view of what life is about.

Ways of Expansion

To begin with, we need a psychological theory that takes into account the idea that humans do expand and moreover seek expansion as a primary motivation. Kids explore everything they can. When they learn words, they start to make up funny words, pig latin, double talk, play with nonsense, codes, start to explore the boundaries of whatever “rules” they’re taught. They do this with games, with climbing. “Be careful” is one of the silliest things to say, because for them the game is to take it to the limit and not get hurt—how far can they try this or that on their bicycles or skateboards or in climbing and not fall down?

People explore every nook and cranny that can be explored. The problem with any theory is that there are some folks out there right now going beyond the boundaries of that theory. So we need a theory that takes this stretching and transcending and transgressing and exploring into account, a theory that recognizes the creativity inherent in the human potential.

Sure, sometimes kids fall down on their skateboards and get a broken bone. And sure, some theories and chemistry experiments blow up into your face and maybe blow up the whole building. Creativity is a dangerous business, it is sometimes brilliant and opens breakthroughs and sometimes so wrong and wicked and stupid that it causes great harm. As one of my favorite philosophers, Alfred North Whitehead (1861-1947) pointed out, “It is the business of the future to be dangerous.”

Theories that seek safety tend also to suppress innovation, they tend to stay with what has worked in the past, or at least has seemed to work. The trouble is, a sharp mind will notice that whatever has been invented just might be improved. This is offensive to the mind that confuses the comfort of a routine, complacency and temporary contentment for oneself,  with ultimate truth. So here is again part of the larger tension of generating theories that dare to look beyond their own ability to look beyond.

So, first, a theory that recognizes the exploratory nature of the mind, into channels that include music, mathematics, philosophy, depth psychology, transpersonal psychology, spirituality, art, humor, and so forth. Nor are these to be taken as “just” expressions of or extensions of “primary” or “basic” instincts. That kind of talk is reductionistic “shrink”-like and unhelpful. We need to recognize these extensions of our mind and body into new possibilities to be essential to human nature.

One of the gifts of existentialism as a philosophy is that it was a counter to essentialism: In the 19th century there was a proliferation of heavy philosophy that, like psychoanalysis, had many good ideas, but also tended to presume too much to define human nature, and thereby put a limit of sorts on how we thought about our potential. It, too, was a bit “shrink-ish.” The phrase, “existence precedes essence,” means that whatever one might think they know about what human nature is about, the living of life can be more true, more complex, and at times extend beyond what any formulation might suggest. Life itself transcends words, and this is illustrated by poets admitting that their intuitions and experiences of love or beauty or the Holy transcends their capacity to capture those experiences in their work.

Beyond Therapy

Finally, the idea that therapy is the change agent should be revised: Instead, perhaps we should think of our professional work more as initiation than as treatment. I envision this work as the teaching of skills so that people can continue to pursue their process of self-development with close friends and family (who share the ethos of psychological reflection and self-improvement), uplifting groups in spiritual communities, occasional personal growth workshops or classes, and the like. It’s a life-time activity and once a degree of stability is re-established, ongoing personal maturation need not be pursued within the frankly costly context of one-to-one or group therapy. I believe in the old Chinese saying, “If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for the rest of his life.”


I’m not saying that the aforementioned factors are “the real causes” of mental illness, but I am quite convinced that they add a little or a lot to the burden of causative factors, depending on the case; and, equally, unless these things become more widely recognized as issues to be addressed as matters of public policy, educational curriculum, and popular discourse, their negative effects will continue to be a not-insignificant factor in the general challenge of mental hygiene in a postmodern era.

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